{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MOHAMED B EL HARRATI","gend":0,"add":"4665 DEERWATCH DR","city":"CHANTILLY","state":"VA","zip":20151,"dob":"1949-09-26","age":"","mstatus":"","insh":"900045814*01","cliId":"","pno":"817\/986-4880","cno":"817\/986-4880   469\/565-5544 ","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Northern Virginia","aligned":"Y","ano":"817\/986-4880, 469\/565-5544, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I69.398","F43.23","E11.9","F03.91","R26.81","R26.2","I63.9","I10.","F33.1","R13.11"],"date":["2021-02-03","2021-02-03","2021-04-09","2021-02-03","2021-04-02","2021-04-02","2021-04-09","2021-04-09","2021-04-09","2021-04-02"],"priorHcc":["","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","70010006310","METFORMIN","TAB 500MG","52","Select","Select",""],["","832003810","OXYBUTYNIN","TAB 5MG","60","Select","Select",""],["","55111064505","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","16714071302","TAMSULOSIN","CAP 0.4MG","-60","Select","Select",""],["","16729004617","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","65862037505","ESCITALOPRAM","TAB 20MG","-30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","64597030160","NUEDEXTA","CAP 20-10MG","62","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","60505014101","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","223176001","SOD CHLORIDE","TAB 1GM","60","Select","Select",""],["","6011254","JANUVIA","TAB 50MG","30","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","-90","Select","Select",""],["","16714071302","TAMSULOSIN HYDROCHLORIDE","","30","Select","Select",""],["","6011254","JANUVIA ","","30","Select","Select",""],["","23155010210","METFORMIN HYDROCHLORIDE","","60","Select","Select",""],["","65862037405","ESCITALOPRAM OXALATE ","","-30","Select","Select",""],["","27241015608","OXYBUTYNIN CHLORIDE ER","","20","Select","Select",""],["","16729004617","ATORVASTATIN CALCIUM ","","30","Select","Select",""],["","60505014101","GLIPIZIDE ","","60","Select","Select",""],["","832003810","OXYBUTYNIN CHLORIDE","","60","Select","Select",""],["","223176001","SODIUM CHLORIDE ","","60","Select","Select",""],["","29300013801","DIVALPROEX SODIUM DR ","","-20","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}